The ReliefBand is an effective adjunct to standard antiemetic agents for controlling nausea induced by cisplatin-based chemotherapy in gynecologic oncology patients.

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Early postoperative feeding in gynecologic oncology patients undergoing intra-abdominal surgery is safe and well tolerated.

Abstract. The goal of this study was to determine whether patterns of expression profiles of p73 isoforms and of p53 mutational status are useful combinatorial biomarkers for predicting outcome in a gynecological cancer cohort. This is the first such study using matched tumor/normal tissue pairs from each patient. The median follow-up was over two years. The expression of all 5 N-terminal isoforms (TAp73, ΔNp73, ΔN'p73, Ex2p73 and Ex2/3p73) was measured by real-time RT-PCR and p53 status was analyzed by immunohistochemistry. TAp73, ΔNp73 and ΔN'p73 were significantly upregulated in tumors. Surprisingly, their range of overexpression was age-dependent, with the highest differences ‰ (tumornormal) in the youngest age group. Correction of this age effect was important in further survival correlations. We used all 6 variables (five p73 isoform levels plus p53 status) as input into a principal component analysis with Varimax rotation (VrPCA) to filter out noise from non-disease related individual variability of p73 levels. Rationally selected and individually weighted principal components from each patient were then used to train a support vector machine (SVM) algorithm to predict clinical outcome. This SVM algorithm was able to predict correct outcome in 30 of the 35 patients. We use here a mathematical tool for pattern recognition that has been commonly used in e.g. microarray data mining and apply it for the first time in a prognostic model. We find that PCA/ SVM is able to test a clinical hypothesis with robust statistics and show that p73 expression profiles and p53 status are useful prognostic biomarkers that differentiate patients with good vs. poor prognosis with gynecological cancers. IntroductionThe p53 gene family consists of p53, p63 and p73. p73 shares substantial homology with p53. In response to DNA damage or deregulated oncogenes, full-length p73 can activate many p53 target genes, thereby inducing cell cycle arrest or apoptosis (1-7). In mice, recent genetic evidence found some support for a helper tumor suppressor role of p73 once p53 is impaired. While p73-/-mice completely lack a cancer phenotype (8), double heterozygous p53+/-, p73+/-mice have a higher tumor burden compared to p53+/-mice (9). In human cancers, however, p73 is not a classical tumor suppressor. The virtual absence of p73 inactivating mutations (10), combined with tumor-associated overexpression of wild-type p73 isoforms including TAp73 in human cancers are in sharp contrast to the notion of a tumor suppressor function. One explanation lies in the fact that, unlike p53, the p73 gene gives rise to multiple isoforms with different and often opposing functions ( Fig. 2A). Whereas the full-length isoform TAp73 largely mimics p53 function, four additional NH 2 -terminally truncated isoforms, ΔNp73, ΔN'p73, Ex2p73 and Ex23p73, act as dominant negative inhibitors of both TAp73 and wild-type p53 (11-13). The isoforms TAp73, ΔN'p73, Ex2p73 and Ex2/ 3p73 are all generated from P1 promoter-derived transcripts via alternative exon splicing (14-...

Postoperative nasogastric tube decompression in gynecologic oncology patients undergoing extensive intra-abdominal surgery does not appear to provide any substantial benefit but significantly increases patient discomfort. As a result of this study, we have eliminated postoperative nasogastric decompression except in highly selected circumstances, such as extensive bowel surgery in patients with prior irradiation or substantial edema from bowel obstruction.

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This report summarizes our experience with the combination of mesna, doxorubicin, ifosfamide, and dacarbazine (MAID) for patients with gynecological sarcomas. We reviewed the records of all patients who had received the MAID regimen for a gynecological sarcoma between 1993 and 2000. The MAID regimen was administered intravenously every 4 weeks in the hospital as follows: (1) mesna 1500 mg/m2/day x 4 days; (2) doxorubicin 15 mg/m2/day x 3 days; (3) ifosfamide 1500 mg/m2/day x 3 days; (4) dacarbazine 250 mg/m2/day x 3 days. The results of treatment with MAID were disappointing. Overall, the response rate was 9% with one complete response and one partial response (both in patients with uterine leiomyosarcoma). We did not observe any responses among the patients with carcinosarcomas of either ovarian or uterine origin. The median progression-free interval and survival were 11 months and 29 months, respectively. This regimen was associated with substantial toxicity (including a death from neutropenic sepsis) as well as high cost and inconvenience due to the requirement for inpatient administration. Although our study contains a limited number of patients with a variety of gynecological sarcomas, our review has led us to discontinue using MAID. It remains to be established if any combination chemotherapy regimen is better than single agent treatment.

Objective: To evaluate the safety and efficacy of early oral feeding after intra-abdominal surgery in gynecologic oncology patients.Methods: During a 1-year period, 200 gynecologic oncology patients undergoing intra-abdominal surgery were enrolled in a randomized controlled trial of early compared with traditional oral postoperative feeding. Patients allocated to early postoperative oral feeding began a clear liquid diet on the first postoperative day and then advanced to a regular diet as tolerated. Patients allocated to traditional postoperative oral feeding received nothing by mouth until return of bowel function (defined as the passage of flatus in the absence of vomiting or abdominal distention), then began a clear liquid diet, and advanced to a regular diet as tolerated.Results: Age, case distribution, surgery length, blood loss, and first passage of flatus were similar in the early and traditional feeding groups. Significantly more patients in the early group developed nausea. Despite this, the incidence of vomiting, abdominal distention, incidence and duration of nasogastric tube use, and percentage of patients who tolerated clear liquid and regular diets on the first attempt were comparable in both groups. Time to development of bowel sounds, time to initiation of clear liquid and regular diets, and hospital stay were significantly longer in the traditional group. Major complications (eg, pneumonia, atelectasis, and wound complications) and febrile morbidity occurred equally in both groups. There were no known anastamotic complications or aspirations in either group. Postoperative changes in hematologic indices and electrolytes were comparable in both groups.Conclusion: Early postoperative feeding in gynecologic oncology patients undergoing intra-abdominal surgery is safe and well tolerated. (Obstet Gynecol 1998;92:94 -7.